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Tuesday, 22 October 2013

During the 1920s, extreme close quarter
living conditions took a heavy toll on the health and life expectancy of the
residents of Cork city. With a population of 80,000, 18,645 of the city’s
inhabitants lived in unsatisfactory conditions with 8,675 inhabitants housed in
719 tenements and small houses. The tenements were generally in a shocking
state of repair; crowded together in such a manner as to make it impossible to
have fresh air and sunlight around each dwelling. The houses were small and
resembled each other merely in their common dilapidation. The alleys, dignified
by the name of streets and infused with a conglomerate of odours, said to be ‘almost
Neapolitan’, began near the riverbank, in sordidness, and ascended the hills to
something like squalor. As bad as the alleys were, the houses were generally
worse. As Frank O’Connor succinctly put it, ‘God had abandoned the lanes of
Cork city, and so had the Corporation’.

In 1926, a report produced by the Cork Town Planning
Association Cork; A civic survey, highlighted
the fact that mortality rates were highest in those districts which contained
the largest amount of ‘insanitary property’. The survey revealed that the
highest mortality rates occurred in dispensary districts three and four, both
of which were located west of Shandon Street on the North side of the city. The
mortality rates here numbered 2.9 per 1000, per annum and 2.7 per 1000, per
annum respectively. Dispensary districts six and seven, located South west of
St. Finbarr’s Cathedral, on the South side of the city recorded the second
highest mortality rate at 2.4 per 1000 per annum and 2.6 per 1000 per annum
respectively. The national mortality rate in 1923 is recorded as been 1.4 per
1000 per annum, making the mortality rate in the Cork Dispensary Districts
twice as high as the national average.

The contemporary finger of blame for the high
mortality rates, and in particular the high infant mortality rates was directed
towards ‘the domestic ignorance of the poor womenfolk in our slum tenements…
and to the shocking ignorance of the duties of motherhood’. However, this
assertion by Professor Alfred O’Rahilly was roundly challenged by Professor
Henry Corby who asserted that;

Out of the mouths of babes comes wisdom, and the poor
women residing in the slums of Cork, who through force of circumstances felt
compelled to ignore medical advice, have taught me what I consider to be a very
valuable lesson.

Ariel view of District Three, on the
north-west slopes of Cork city circa 1930. Source: Cork City Council.

'God had abandoned the lanes of Cork city, and so had the Corporation'. View of District Four, taken from the North Cathedral, circa 1930. Source: Cork City Council.

Addressing an article in the British Medical Journal relating to ante-natal care in private
practice, Corby lamented that there had been little progress in the field of
obstetrics over the previous fifty years to 1924, especially in regard to the
preventative treatment of puerperal sepsis; a fatal illness caused by severe
infection spread via the bloodstream, and generally contracted after a
prolonged hospital confinement. During the 1920s, physicians routinely
proscribed between ten and eighteen days post natal bed rest, and as a result,
puerperal sepsis had been an all too common cause of death among women,
regardless of social status. Reflecting
on his time spent as visiting physician to the Cork Maternity Hospital, Corby
noted that he had been ‘forcibly struck’ by two things;

One, was the thorough contempt that the patients of
the lanes exhibited for the medical science with regard to the amount of rest
that should be taken after a confinement. The other was that puerperal sepsis
was unknown among these [Cork] women, though they lived in the midst of squalid
poverty and in surroundings which were the reverse of sanitary.

Corby contacted the matron of the Cork Maternity
Hospital, and made inquires as to the duration of post natal bed rest taken by
women under her care. The matron reported that the majority of women had
‘gotten up and gone about their daily chores on the third day after giving
birth’. Furthermore, during her ten year tenure at the Cork Maternity Hospital,
the Matron stated that only one case of death caused by sepsis had been
recorded. Corby concluded that the adoption and application of the example set
by ‘the women of the lanes’ to his own patients ‘resulted in good practical
results’.

Similarly, an examination of J.C. Saunders, Typhoid epidemic in Cork city 1920, suggests
that high mortality rates in the Cork dispensary districts were not necessarily
caused by unsanitary practices among their inhabitants. Saunders account of the
typhoid epidemic in Cork, ‘the biggest of its kind in the city and probably of
the country also’, found that there had been 243 reported cases ‘but that it
was highly probable that this figure represented only a portion of those which
actually occurred’. The heaviest incidence was recorded in the northwest ward,
that being the congested areas west of Shandon Street, where ‘there were a
large number of insanitary and overcrowded dwellings and where the general
standard of living is lower than that for the city generally’. The maximum
incidence occurred in the eleven to fifteen age group, the youngest victim was
three and a half years old and the oldest was seventy two years old.

An investigation focusing on the water supply
concluded that it was contaminated with Balantidium Coli (B.coli). B. Coli
causes infection when ingested by humans, faecal-oral being the commonest mode
of transmission and it usually affects the large-intestine. Symptoms include
diarrhoea, nausea, vomiting, fever, and severe fluid loss, a perfect disease to
spread rapidly through a community living in extreme close quarters. The source
of the contamination was identified as being discharge from Our Lady’s Cork
Mental Hospital, which entered the River Lee through a sewage pipe, twenty
yards from the pure water basin which supplied the drinking water for the
entire city. The focus of the investigation turned to Our Lady’s Hospital,
where it was established that typhoid had been endemic for over twenty years
previously. The cause by which the
hospital had become ‘a reservoir of infection’ was traced to the institutions
milk supply, which was found to be contaminated as a result of unsanitary
practices at the production stage.

The overcrowded districts may well have been the
‘breeding ground for disease’ that many contemporary commentators depicted, and
lives lived in squalid poverty in unsanitary accommodation presented a daily
menace to the health and life of the workers and the poor. However, there is
little doubt that the close-quarter habitation, an enforced condition of the
physical state of the tenements, intensified the impact of external influences
on their captives, who were victims of, rather than creators of their
environment.

Michael Dwyer is a PhD candidate at the School of History, University College Cork. His current research relates to the historical significance of diphtheria and the roll-out of childhood immunisation programmes in Ireland. He is the winner of the James and Mary Hogan Prize in History (2011), the Saothar/IHSA Labour History Award (2012), and the Centre for the History of Medicine in Ireland Essay Prize (jointly, 2013). For further information see this link.